BACKGROUND: Since 2002, priority Model for End-stage Liver Disease (MELD) exception status has been given to patients with hepatocellular carcinoma (HCC) who meet the Milan criteria. Since then, the number of liver transplantations performed in patients with HCC has increased, but to the authors' knowledge, few studies to date have examined the effect of MELD exception recommendations on therapy use and survival rates in a nationwide sample. The current study examines therapy use and long-term survival rates among patients with HCC tumors meeting the Milan criteria in the post-MELD exception era. METHODS: The current study is a retrospective cohort study of 2179 patients with localized HCC meeting the Milan criteria who were registered between 2004 and 2007 in the Surveillance, Epidemiology, and End Results database. RESULTS: A total of 43% of patients did not receive any specific therapy. Overall, the 5-year relative survival rate for patients receiving only supportive care was dismal at 24% (95% confidence interval [95% CI], 21%-27%), whereas that for patients undergoing liver transplantation was 77% (95% CI, 71%-82%). Long-term survival was found to be dependent on age, race=ethnicity, and type of therapy received. A multivariate Cox proportional hazards model adjusted for age, race=ethnicity, and type of therapy received demonstrated that, compared with white patients, black patients had significantly poorer survival outcomes (hazards ratio, 1.23; 95% CI, 1.03-1.47 [P 5.02]), whereas Asian=Pacific Islander patients had significantly better survival rates when compared with white patients (HR, 0.66; 95% CI, 0.57-0.77 [P <.001]). CONCLUSIONS: Despite having localized disease that met transplantation criteria, nearly 50% of the large nationwide cohort of patients with HCC in the current study received only supportive care and had dismal 5-year relative survival rates, especially among black patients. Cancer 2014;120:1725-32. V C 2014 American Cancer Society.KEYWORDS: SEER, survival analysis, liver transplantation, localized hepatocellular carcinoma, Model for End-stage Liver Disease. INTRODUCTIONHepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. 1,2 It is the fifth leading cause of cancer in men and the seventh leading cause of cancer in women in United States. 3,4 Although incidence rates for most cancers in United States are declining, incidence rates for HCC in both men and women continue to rise. 3 It is estimated that there will be 30,640 new HCC cases diagnosed in 2013 (22,720 in men and 7920 in women). 3 Similarly, mortality rates for HCC have also increased over the past 2 decades and it is estimated that there will be 21,670 HCC-related deaths in 2013 (14,890 in men and 6780 in women). 3 Despite advances in screening and early detection, HCC still has a poor overall 5-year survival rate of 16% according to the data published by the Surveillance, Epidemiology, and End Results (SEER) program between 2002 and 2008. 3

Background: There is a growing preference for the use of marijuana for medical purposes, despite limited evidence regarding its benefits and potential safety risks. Legalization status may play a role in the attitudes and preferences toward medical marijuana (MM). Objectives: The attitudes and beliefs of cancer patients in a legalized (Arizona) versus nonlegalized state (Texas) regarding medical and recreational legalization and medical usefulness of marijuana were compared.

Carcinoids are rare neuroendocrine tumours that occur primarily in the gastrointestinal tract. Carcinoid heart disease is characterized by fibrous plaque deposition on the endocardial surface of the cardiac valves and chambers. It affects the right heart valves in 85% of cases and the left heart valves in 15%. We present an unusual case of a patient with metastatic carcinoid heart disease in whom typical carcinoid aortic and mitral valve lesions developed 2 years prior to the development of severe right-sided carcinoid valvular heart disease.

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